Recombinant hirudin as a new anticoagulant during cardiac operations instead of heparin: Successful for aortic valve replacement in man

Rieß, Friedrich-Christian; Löwer, C; Seelig, Christoph; Bleese, Niels; Kormann, Joachim; Müller‐Berghaus, Gert; Pötzsch, Bernd

doi:10.1016/s0022-5223(05)80033-9

Cited by 85 publications

(36 citation statements)

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“…10 A longer CPB time would have probably made supplemental r-hirudin administration mandatory, as reported previously. 9 Our observations indicate that the published regimens of r-hirudin administration for CPB anticoagulation should be adapted in patients already receiving a continuous infusion of r-hirudin and that the current dose of 0.2 mg·kg -1 r-hirudin in the CPB priming volume can result in transient excessive anticoagulation.…”

Section: Discussionmentioning

confidence: 79%

“…The rhirudin dose administered for CPB anticoagulation was 0.1 mg·kg -1 which is half the recommended dose in humans given r-hirudin for CPB anticoagulation. 9 This low r-hirudin dose resulted, before CPB onset, in ACT and ECT values above the recommended therapeutic targets for CPB anticoagulation (Table II). The r-hirudin dose administered in the CPB priming volume, based on a previously published report, 9 seems relatively high because both ACT and ECT values in this case report were far above therapeutic targets just after CPB onset (Table II).…”

Section: Discussionmentioning

confidence: 99%

“…The patient received r-hirudin for 13 dy before cardiac surgery which is longer than previously reported. 9 As a result, both ACT and ECT were prolonged before anticoagulation for bypass (see Table II). The rhirudin dose administered for CPB anticoagulation was 0.1 mg·kg -1 which is half the recommended dose in humans given r-hirudin for CPB anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…8 Anticoagulation with r-hirudin after cardiac surgery with r-hirudin-based CPB anticoagulation has been reported previously. 9 Based on that report, and because of the short half life of r-hirudin, we started the continuous r-hirudin infusion on the 2nd postoperative hour because chest tube blood loss was < 50 ml·hr -1 although aPTT was prolonged (Table III). Postoperative blood loss (Figure) paralleled r-hirudin reintroduction in the immediate postoperative period whereas, on the first postoperative day, r-hirudin infusion was resumed without any effect on blood loss through the chest tubes.…”

Section: Discussionmentioning

confidence: 99%

“…Table II indicates the evolution of ACT and r-hirudin concentrations derived from ECT after r-hirudin bolus administration before, during and immediately after CPB. Because both ACT and ECT were above the recommended therapeutic targets for CPB anticoagulation with r-hirudin, 9 no supplementary r-hirudin was given during CPB. There were no clinically detectable bleeding or clotting in the cardiopulmonary bypass circuit or in the operative field.…”

Section: Anticoagulation For Cardiopulmonary Bypassmentioning

confidence: 99%

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Recombinant hirudin anticoagulation for aortic valve replacement in heparin-induced thrombocytopenia

Longrois

Maistre

Bischoff

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To report the case of a patient with HIT that received a prolonged infusion of r-hirudin (lepirudin; Refludan®; Hoechst, France) before, during and after cardiopulmonary bypass (CPB) for aortic surgery. Although administration of r-hirudin for CPB anticoagulation has previously been reported, many questions persist concerning the best therapeutic regimen for CPB anticoagulation as well as the time of onset and the doses for postoperative anticoagulation.Clinical Features: A 65-yr-old man was admitted for surgery of aortic stenosis after an episode of acute pulmonary edema complicated by deep venous thrombosis in the context of documented HIT. The patient received r-hirudin for 13 dy before surgery at doses (0.4 mg·kg -1 bolus followed by 0.15 mg·kg -1 ·hr -1 continuous infusion) that maintained activated partial thromboplastin time (aPTT) ratios between 2 and 2.5. Anticoagulation for CPB was performed with r-hirudin given as 0.1 mg·kg -1 iv bolus and 0.2 mg·kg -1 in the CPB priming volume. Anticoagulation during CPB was monitored with the whole blood activated coagulation time and ecarin clotting time (ECT) performed in the operating room with values corresponding to r-hirudin concentrations > 5 µg·ml -1 during CPB. Anticoagulation during CPB was uneventful. Two bleeding episodes, related to the r-hirudin regimen and necessitating allogeneic blood transfusion, occurred after surgery. Conclusion:This case report confirms previous experience of the use of r-hirudin for anticoagulation during CPB and provides additional information in the context of prolonged r-hirudin infusion before and after CPB.Objectif : Rendre compte du cas d'un patient qui présentait une TIH et qui a reçu une perfusion prolongée de r-hirudine (lépirudine; Refludan®; Hoechst, France) avant, pendant et après la circulation extracorporelle (CEC) lors d'une intervention chirurgicale aortique. L'administration de l'anticoagulant r-hirudine pour la CEC est un fait connu, mais de nombreuses questions persistent sur le meilleur schéma thérapeutique à utiliser pendant la CEC et, sur le délai d'installation de l'anticoagulation et sur les doses à respecter après l'opération.Éléments cliniques : Un homme de 65 ans a été admis pour l'opération d'une sténose aortique survenue après un épisode d'oedème pulmonaire aigu compliqué d'une thrombose veineuse profonde dans le contexte d'une TIH connue. Le patient a reçu de la r-hirudine pendant 13 jrs avant l'intervention (bolus de 0,4 mg·kg -1 suivi d'une perfusion continue à 0,15 mg·kg -1 ·hr -1 ) pour maintenir les ratios de temps de céphaline activé entre 2 et 2,5 (aPTT). Pendant la CEC, l'anticoagulation a été réalisée avec de la r-hirudine administrée en bolus de 0,1 mg·kg -1 iv et 0,2 mg·kg -1 dans le volume d'amorçage de la CEC. Elle a été contrôlée avec les test du temps de coagulation activé du sang complet et du temps de coagulation de l'écarine (TCE) réalisés dans la salle d'opération selon des valeurs qui correspondent à des concentrations de r-hirudine > 5 µg·ml -1 . Aucun incident n'a mar...

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Anticoagulation For Cardiopulmonary Bypassmentioning

confidence: 99%

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